Giving Birth

Deciding where to have your baby is an important decision for you and your partner and we believe that you should give birth in an environment where you feel safe, comfortable and relaxed.

You and your family are placed at the centre of care and involved in all decision-making regarding your labour and birth. You can give birth at home, or in a Western Isles maternity unit. You can discuss your options of place at birth at any time throughout your antenatal period.

What To Do When You Go Into Labour

You're unlikely to mistake the signs of labour when the time comes. If you are in any doubt, please contact the Maternity unit.

The main signs of labour starting are strong, regular contractions, and a 'show' when the plug of mucus sealing your cervix comes away. Other signs that you are going into labour can include your waters breaking, backache, vomiting or nausea, diarrhoea. Later in labour, you may experience an urge to go to the toilet caused by your baby's head pressing on your bowel.

You will find below some information about items listed below. This is also available in your handheld maternity record.
  • Contractions
  • Coping at the beginning of labour
  • The "show"
  • Waters breaking
  • The stages of labour
  • Assessement of progress
  • Coming to the Maternity Unit

Make sure you can be contacted at all times and that transport and childcare has been arranged (day or night). Here is a short checklist of things you may want to pack:

  • Changing clothes for you
  • Snacks and energy drink (for you and your birthing partners)
  • Camera, why not some music (don't forget your charger and some speakers/headphones)
  • Your mobile phone or change for the telephone
  • Car seat for your baby

Pain Relief During Labour

Labour can be painful and knowing about the types of pain relief available to you will help you make informed choices about what is right for you and your baby through labour and birth.
Write down your wishes with your birth preferences, but remember that you should keep an open mind. You may find that you want more pain relief than you had planned, or your midwife may suggest more effective pain relief to help the delivery. Different ways of relieving the pain are listed below:
  • Gas and air (entonox)
  • Injections of opiates such as diamorphine
  • TENS machine
  • Epidural anaesthesia– only available at certain times.

Contractions

When you have a contraction, your womb (uterus) gets tight and then relaxes. You may have had contractions throughout your pregnancy, particularly towards the end. During pregnancy, these painless tightenings are called Braxton Hicks contractions. When you are having regular, painful contractions that feel stronger and last more than 30 seconds, labour may have started. Your contractions will become longer, stronger and more frequent.

During a contraction, the muscles in your womb contract and the pain increases. If you put your hand on your abdomen, you can feel it getting harder. When the muscles relax, the pain fades and your hand will feel the hardness ease. The contractions are pushing your baby down and opening your cervix (entrance to the womb) ready for your baby to go through.

Your midwife will probably advise you to stay at home until your contractions are frequent. When you are having regular contractions it is best to call the maternity unit for more advice.

Coping at the Beginning of Labour

If you have attended Parentcraft classes, this is the time for you and your birthing partner to use all the good tips other couples and midwives have shared with you... Here is a little reminder of the main ones:

  • You can be up and moving about if you feel like it
  • You can drink fluids and may find isotonic drinks (sports drinks) help keep your energy levels up
  • You can also snack, although many women don't feel very hungry and some feel sick
  • As the contractions get stronger and more painful, you can try relaxation and breathing exercises – your birth partner can help by doing them with you
  • Your birth partner can rub your back as it may help relieve the pain

Waters Breaking

Most women's waters break during labour, but it can also happen before labour starts. Your unborn baby develops and grows inside a bag of fluid called the amniotic sac. When it's time for your baby to be born, the sac breaks and the amniotic fluid drains out through your vagina. This is your waters breaking.

You may feel a slow trickle, or a sudden gush of water that you cannot control. To prepare for this, you could keep a sanitary towel (but not a tampon) handy if you are going out, and put a plastic sheet on your bed.

Amniotic fluid is clear and a pale straw colour. When it comes out, it may be a little blood-stained to start with.

If your waters break call the Maternity unit for you and your baby to be assessed and further information about the plan to follow as there is a risk of infection if labour does not start within 24-36 hours.

The Stages of Labour

There are three stages to labour:

The first stage, when the cervix gradually opens up (dilates)
  • The cervix needs to open about 10cm for a baby to pass through. This is called 'fully dilated'. Contractions at the start of labour help to soften the cervix so that it gradually opens.
  • Sometimes the process of softening can take many hours before you are in what midwives call ‘established labour’. Established labour is when your cervix has dilated to at least 4cm.
  • Once labour is established, the midwife will check you from time to time to see how you are progressing. In a first labour, the time from the start of established labour to full dilation is usually between 6 and 12 hours. It is often quicker for subsequent pregnancies.
The second stage, when the baby is pushed down the vagina and is born

This stage begins when the cervix is fully dilated and lasts until the birth of your baby. Your midwife will help you find a comfortable position and will guide you when you feel the urge to push.

Find a position

It will be a balance of which position you prefer and which will make labour easier for you. Gravity can be very helpful in labour and being upright can help speed labour along and relieve back pain. You might want to stand, sit on a birth ball, kneel or squat (although squatting may feel difficult if you are not used to it).

If you are very tired, you might be more comfortable lying on your side rather than propped up with pillows. This is also a better position for your baby. If you've had backache in labour, kneeling on all fours might be helpful. It's up to you. Your position is your choice.

The third stage is when the placenta comes away from the wall of the womb and is also pushed out of the vagina.

Assessment of Progress

The midwife will ask you about what has been happening so far and will examine you. If you are having a home birth, then this examination will take place at home.

The midwife will:
  • take your pulse, temperature and blood pressure and check your urine
  • feel your abdomen to check the baby's position and record or listen to your baby's heart
  • probably do an internal examination to find out how much your cervix has opened - they can then tell you how far your labour has progressed
These checks will be repeated at intervals throughout your labour. Always ask about anything you want to know. If you and your partner have made a birth plan, show your midwife so she knows what kind of labour you want and can help you to achieve it.

Your questions about:

We thought you may have some some questions about the following items on the next page. The answers displayed can also be found in your Handheld Maternity Record.


Your baby is overdue

Pregnancy normally lasts about 40 weeks. Most women go into labour within a week either side of this date, but some women go overdue.

  • If your labour doesn't start by the time you are 40 weeks pregnant, your midwife will offer you a 'membrane sweep'. This involves having a vaginal examination, which stimulates the neck of your womb (known as the cervix) to produce hormones that may trigger natural labour. You don't have to have this – you can discuss it with your midwife.

  • If your labour still doesn't start naturally after this, your midwife or doctor will suggest a date to have your labour induced (started off), usually at around 10 days overdue. If you don't want your labour to be induced, and your pregnancy continues to 42 weeks or beyond, you and your baby will be monitored. Your midwife or doctor will check that both you and your baby are healthy by giving you ultrasound scans and checking your baby's movement and heartbeat. If your baby is not doing well, your doctor and midwife will again suggest that labour is induced.


Induction is always planned in advance, so you'll be able to discuss the advantages and disadvantages with your doctor and midwife, and find out why they think your labour should be induced. It's your choice whether to have your labour induced or not.

You may be offered induction of labour earlier if you have complications in your pregnancy or if you are aged 40 or over.

Your baby's heart monitoring in labour

Your baby's heart will be monitored throughout labour. Your midwife will watch for any marked change in your baby's heart rate, which could be sign that the baby is distressed and that something needs to be done to speed up the delivery. There are different ways of monitoring the baby's heartbeat:

  • Your midwife may listen to your baby's heart intermittently, but for at least one minute every 15 minutes when you are in established labour, using a hand-held ultrasound monitor – this method allows you to be free to move around. This will be offered if you are low risk and all is well in labour.
  • Your baby's heartbeat and your contractions may also be followed electronically through a monitor linked to a machine called a CTG (cardiotocography) – the monitor will be strapped to your abdomen on a belt.
  • Alternatively, a clip can be put on your baby's head to monitor their heart rate – the clip is put on during a vaginal examination and your waters will be broken if they have not already done so. Ask your midwife or doctor to explain why they feel that the clip is necessary for your baby.

Vitamin K

You'll be offered an injection of vitamin K for your baby, which is the most effective way of helping to prevent a rare bleeding disorder (haemorrhagic disease of the newborn). Your midwife should have discussed this with you beforehand. If you prefer that your baby doesn't have an injection, oral doses of vitamin K are available. Further doses are needed for babies who received vitamin K by mouth.

The pushing stage

When your cervix is fully dilated you can start to push when you feel you need to during contractions. The urge to push can be irresistible and the pressure of the baby's head may make you feel like you need to empty your bowels. This is your body's way to tell you where and when to push. Your midwife will support and encourage you.  If you have had an epidural you may not feel a strong urge to push. You may only feel some pressure sensations and may need more guidance from the midwife to help you push.

This stage of labour may take an hour or so of hard work but you are near the end.

The birth

During the second stage, the baby’s head moves down until it can be seen. When the head is almost ready to be born, the midwife will ask you to stop pushing, and to pant or puff a couple of quick short breaths, blowing out through your mouth. This is so that your baby’s head can be born slowly and gently, giving the skin and muscles of the perineum (the area between your vagina and anus) time to stretch without tearing.

The skin of the perineum usually stretches well, but it may tear. Sometimes, to help the baby be born quickly, or if a significant tear seems likely, the midwife or doctor will inject local anaesthetic and cut an episiotomy. Afterwards, the cut or tear is stitched up again and heals.

Once your baby’s head is born, most of the hard work is over. With one more gentle push the body usually follows. You can have your baby lifted straight onto you before the cord is cut by your midwife or birth partner.

Your baby may be born covered with a white, greasy substance known as vernix, which has acted as protection in the uterus.

Caesarean Section

As a Caesarean Section involves major surgery, it is usually only performed when the benefits of this kind of birth outweigh the risks involved with the operation.

Your baby is delivered by making an incision on the lower abdomen (just below your bikini line) and then into your womb (uterus).

Most Caesarean Sections are performed under epidural or spinal anaesthesia, which minimises risks to you and means that you're awake for the delivery of your baby. A general anaesthetic (which puts you to sleep) is rarely used, but may be necessary in some instances if your baby needs to be delivered quickly.

If you have an epidural or spinal anaesthesia, you won't feel pain, just some tugging and pulling as your baby is delivered. A screen will be put up so that you can't see what's being done. The doctors will talk to you and let you know what's happening.

It takes between five to 20 minutes to deliver the baby, and the whole operation takes about 40-60 minutes. One advantage of an epidural or spinal anaesthetic is that you're awake at the moment of delivery and can see and hold your baby immediately. Your birth partner can be with you. Your recovery after a Caesarean Section may take some time and you will need to remain in the hospital for at least 48 hours after the delivery. Most women who have one Caesarean Section are able to give birth vaginally when they have another baby.

Caesarean Section (planned)

How to best prepare for a planned caesarean?

The following infornation will help prepare you for your planned Caesarean Section. It also provides information on what you can do after your baby is born to help speed your recovery.

On the night before Your Caesarean

We advise that you eat and drink normally until midnight before your Caesarean Section. From midnight until 6am on the day of your operation, your diet will be restricted and you will be asked to take one of your Ranitidine tablets at 10pm on the night before your operation and 8am on the day of your operation.

As with all operations, we ask that you do not wear any make-up, nail varnish, false nails or jewellery, apart from a plain wedding ring which can be taped around your finger. If you wear contact lenses, you will be required to remove these before you go into theatre so it would be advisable to bring your glasses.

During Your Caesarean Section

We would like to make the birth of your baby a comfortable experience, one birthing partner can be with you and staff will introduce themselves and their role and will be able to answer any questions you may have.

You will usually be in theatre for about an hour in total:
  • The anaesthetist will make preparations for you to have your spinal anaesthetic to make you numb from the chest down (you will be able to stay awake ready to see your baby being born)
  • Your midwife will then listen to the baby's heart beat
  • When you are numb; a urinary catheter will be sited, a tube that goes into your bladder which will help to keep your bladder empty during the operation.
  • A screen will then be put up so that the doctors can prepare for your operation.

Your baby will be born through a cut or 'incision' into your lower abdomen (tummy). You may feel some pulling or tugging sensations as your baby is born but you will not feel any pain.

When your baby is born:

If you wish, you can have the screen dropped so that you can see your baby.

  • Your baby will then go to the midwife to be dried and then come to you for a cuddle.
  • You may wish to have skin to skin at this point or you can have skin to skin after your Caesarean Section has been stitched.

After your Caesarean Section

You will initially be taken to a shared recovery area after your Caesarean Section and then back to the Maternity Ward.

You will be offered skin to skin contact with your baby regardless of your chosen method of feeding and will be given assistance to feed your baby should you require it.

Getting back to normal after your Caesarean Section

It is important that you begin to eat and drink as soon as you feel able to after your Caesarean Section. This will help your body to recover much faster after your surgery.

  • Prevent thrombosis or blood clots

When your spinal anaesthetic has worn off; staff will help you to get out of bed, being mobile helps to prevent thrombosis or blood clots. You will also need to wear your surgical stockings and you will be given blood thinning injections daily for five to seven days following your Caesarean Section.

  • Looking after your bladder

When you are mobile, your catheter can be removed and you should measure the first void of urine in the jug/bowl provided. If you have any problems passing urine such as pain or leaking, even when you are at home, please inform your midwife or doctor.

  • Prevent pain

You will be prescribed regular pain killers to take in hospital. Please make sure you have a supply of paracetamol and ibuprofen ready for when you go home, providing that you are not allergic to them or have been advised against taking them.

  • Looking after your wound

You should take a daily shower to keep the wound clean and dry. You should wear loose fitting cotton underwear that are big enough to pull up above the wound so that it does not rub. You may notice some bruising and a loss of feeling/sensation in the area around the scar. This is normal after a Caesarean Section and should not be permanent.
If you notice any redness, oozing, offensive smell from the wound or you feel feverish (going hot and cold or you have a temperature) you should tell your midwife or doctor.

  • Observe your bleeding

You may bleed vaginally after your caesarean for up to six weeks. You should change your maternity pads frequently, every 3-4 hours and make sure that you wash your hands both before and after going to the toilet and changing your pads.
You should tell your midwife or doctor if your vaginal bleeding increases, you are passing clots or it becomes irregular or painful.

After you go home

You will be visited at home by one of the community midwifery team on the day after you go home from hospital. They will check both you and your baby and help you with feeding if you require it. Staff will then make another appointment to see you and your baby depending on your individual circumstances. Staff will then make another appointment to see you and your baby depending on your individual circumstances.
If you have any concerns or questions please let them know.

You will be discharged from the community midwives from 10 days after the birth of your baby, at which point, your health visitor will take over your baby's care. However we can visit up to 28 days should you or your baby require it. You will usually hear from the health visitor at around 10 to 14 days after the birth of your baby and they will monitor your baby's progress up until school age.

You should make an appointment to see your GP at 6 weeks after the birth of your baby. This appointment is a routine general wellness check and will also give you an opportunity to discuss contraception and future smear tests.

Ventouse and Forceps

About one woman in eight has an assisted birth, where forceps or a ventouse suction cup are used to help the baby out of the vagina. This can be because:
  • your baby is distressed
  • your baby is in an awkward position
  • you're too exhausted

Both ventouse and forceps are safe and only used when necessary for you and your baby. The obstetrician caring for you will decide whether to use either ventouse or forceps depending on which is most likely to be safe and effective. A paediatrician may be present to check your baby's health. A local anaesthetic is usually given to numb the birth canal (the passageway the baby travels to be born, from womb to vagina) if you haven't already had an epidural. If your obstetrician has any concerns, you may be moved to an operating theatre so that a Caesarean Section can be carried out if needed.

As the baby is being born, a cut (episiotomy) may be needed to make the vaginal opening bigger. Any tear or cut will be repaired with stitches. Depending on the circumstances, your baby can be delivered and placed onto your tummy, and your birthing partner may still be able to cut the cord if they want to.

Tears and Episiotomies

Sometimes during the process of giving birth, a doctor or midwife may make a cut in a woman's perineum (the area between the vagina and anus). The cut makes the opening of the vagina a bit wider, allowing the baby to come through it more easily. An episiotomy may be recommended if your baby develops a condition known as foetal distress. Foetal distress is where the baby's heart rate significantly increases or decreases before birth. This means that the baby may not be getting enough oxygen and has to be delivered quickly to avoid the risk of birth defects or stillbirth.

Vitamin K

You'll be offered an injection of vitamin K for your baby, which is the most effective way of helping to prevent a rare bleeding disorder (haemorrhagic disease of the newborn). Your midwife should have discussed this with you beforehand. If you prefer that your baby doesn't have an injection, oral doses of vitamin K are available. Further doses are needed for babies who received vitamin K by mouth.